| NPI | 1780126284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT37901) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 292309) |
| Enumeration Date | 2016-11-15 |
| Last Update Date | 2022-05-03 |